Rituximab induced cerebral venous sinus thrombosis in a patient with anti-N-methyl-D-aspartate receptor-antibody encephalitis: a case report and review of literature.

IF 0.9 Q3 MEDICINE, GENERAL & INTERNAL
S Maathury, R Thevarajah, T Chang
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引用次数: 0

Abstract

Background: Cerebral venous sinus thrombosis has not been reported in anti-N-methyl-D-aspartate receptor-antibody encephalitis in the absence of an underlying thrombotic state while rituximab induced cerebral venous sinus thrombosis is rarely reported. We report a patient with anti-N-methyl-D-aspartate receptor-antibody encephalitis without a prothrombotic state who developed cerebral venous sinus thrombosis following rituximab treatment.

Case presentation: A 15-year-old Sri Lankan girl who had been in remission following an episode of anti-N-methyl-D-aspartate receptor-antibody encephalitis 2 years ago, presented with a relapse of anti-N-methyl-D-aspartate receptor-antibody encephalitis characterized by recurrent seizures, mutism, and cognitive abnormalities. Since response was inadequate to first-line immunotherapy, she was administered four doses of rituximab at weekly intervals. Two days after the fourth dose, she developed increasing headaches, and her cranial magnetic resonance venogram confirmed the development of cerebral venous sinus thrombosis. Screening for prothrombotic states were negative. She made an unremarkable recovery following anticoagulation.

Conclusion: This case highlights the occurrence of the rare but serious complication of cerebral venous sinus thrombosis following rituximab in the context of anti-N-methyl-D-aspartate receptor-antibody encephalitis and informs the clinician to be wary of new onset headache in patients with anti-N-methyl-D-aspartate receptor-antibody encephalitis treated with immunotherapy.

抗 N-甲基-D-天冬氨酸受体抗体脑炎患者利妥昔单抗诱发脑静脉窦血栓形成:病例报告和文献综述。
背景:抗-N-甲基-D-天冬氨酸受体抗体脑炎患者在没有潜在血栓形成状态的情况下,脑静脉窦血栓形成尚未见报道,而利妥昔单抗诱发脑静脉窦血栓形成的报道很少。我们报告了一名抗 N-甲基-D-天冬氨酸受体抗体脑炎患者,她在接受利妥昔单抗治疗后出现了脑静脉窦血栓:一名15岁的斯里兰卡女孩在两年前抗N-甲基-D-天冬氨酸受体抗体脑炎发作后病情得到缓解,后来抗N-甲基-D-天冬氨酸受体抗体脑炎复发,表现为反复发作、缄默和认知异常。由于对一线免疫疗法的反应不充分,她接受了四次利妥昔单抗治疗,每次间隔一周。第四剂后两天,她的头痛加剧,头颅磁共振静脉造影证实她患上了脑静脉窦血栓。血栓前状态筛查结果为阴性。抗凝治疗后,她恢复得很好:本病例强调了抗N-甲基-D-天冬氨酸受体抗体脑炎患者使用利妥昔单抗后发生脑静脉窦血栓形成这一罕见但严重的并发症,并提醒临床医生警惕接受免疫治疗的抗N-甲基-D-天冬氨酸受体抗体脑炎患者新发头痛。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Journal of Medical Case Reports
Journal of Medical Case Reports Medicine-Medicine (all)
CiteScore
1.50
自引率
0.00%
发文量
436
期刊介绍: JMCR is an open access, peer-reviewed online journal that will consider any original case report that expands the field of general medical knowledge. Reports should show one of the following: 1. Unreported or unusual side effects or adverse interactions involving medications 2. Unexpected or unusual presentations of a disease 3. New associations or variations in disease processes 4. Presentations, diagnoses and/or management of new and emerging diseases 5. An unexpected association between diseases or symptoms 6. An unexpected event in the course of observing or treating a patient 7. Findings that shed new light on the possible pathogenesis of a disease or an adverse effect
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